Characteristics and prognostic value of pre-treatment ¹⁸F-FDG PET in neuroblastoma.

Abstract

This study aimed to evaluate the imaging features and prognostic value of metabolic parameters derived from pretreatment ¹⁸F-FDG PET in pediatric neuroblastoma (NB) patients, and to establish a prognostic prediction model. This retrospective analysis included pediatric patients with extracranial embryonic solid tumours, notably NB, who underwent pretreatment ¹⁸F-FDG PET between Jan 2013 and Sep 2023 (NCT06190574). PET parameters were recorded, including SUVmax, SUVmean and their liver-normalized ratios (SUVmax/liver, SUVmean/liver), TLG, MTV. The diagnostic value of ¹⁸F-FDG PET for distinguishing NB were calculated. Correlations between metabolic parameters and clinical variables (age, gender, NSE, LDH, ferritin, INSS, and INRGSS stages) were analyzed. Survival analysis using the Kaplan-Meier method was performed to identify predictors of PFS and OS. A nomogram incorporating variables selected by univariate COX and LASSO regression was created, with its discrimination and calibration assessed. Among 81 patients, 41 were pathologically confirmed as NB, yielding an ¹⁸F-FDG PET sensitivity of 92.7% and specificity of 95.0%. Metastasis was associated with all serological markers and PET parameters. TLG and MTV correlated with NSE and LDH. Of the confirmed NB patients, 37 were eligible for inclusion in survival analysis. PFS was associated with age, maximum diameter, SUVmax, TLG, MTV, ferritin, NSE and LDH. OS was significantly influenced by age, maximum diameter, SUVmax, SUVmean SUVmax/liver, SUVmean/liver, TLG, MTV, NSE, LDH. The prognostic model incorporating maximum diameter, MTV and NSE exhibited favorable discrimination and calibration. ¹⁸F-FDG PET provides valuable diagnostic and prognostic information for NB. The proposed nomogram integrating maximum diameter, MTV, and NSE serves as a practical tool for assessing patient condition and predicting survival outcomes. NCT06190574.